Systems for accommodating separation of body parts in auditory prostheses

ABSTRACT

An auditory prosthesis includes a fixation system manufactured in whole or in part from a deformable material, such as a viscoelastic material. The viscoelastic material responds viscously to loads applied over an extended period of time. Thus, the material is able to accommodate growth of a recipient&#39;s anatomy without becoming disconnected or misaligned from any attachment points. This allows the device to accommodate growth of a recipient over time.

BACKGROUND

A direct acoustic cochlear implant is fixed at two locations. At a firstend, the device is fixed to a skull surface by a fixation system and anumber of bone screws. At a second end, it is attached to the cochlea bymeans of a stapes prosthesis or preloaded to the ossicular chain. Thedirect acoustic cochlear implant includes an actuator, a coupling rod,an artificial incus, and/or a drive pin, to deliver stimulation directlyto the cochlea.

As the skull of a juvenile grows, the distance between the attachmentpoint at the skull surface and the attachment point at the inner ear ormiddle ear structures increase. This could result in a dislocation ormisalignment of the connections. Most likely, the connection to theinner ear or middle ear structures will loosen because that connectionis weaker than the connection to the skull surface. A dislocated ormisaligned connection to the inner ear or middle ear results in loss oftherapy efficiency or efficacy. Therefore, direct acoustic cochlearimplants are contra-indicated for recipients that do not have full-grownanatomy, e.g. skull anatomy. This can exclude pediatrics, teens, andother potential recipients whose anatomy is still growing, from thebenefits of such an acoustic implant.

SUMMARY

In an auditory prosthesis, a part of a fixation system (e.g., a partthat holds an actuator) is manufactured from a deformable material, suchas a viscoelastic material. The viscoelastic material respondselastically to loads that are applied in a short time, but respondsviscously when loads are applied over an extended period of time. Thus,the material is able to accommodate growth of a recipient's anatomywithout becoming disconnected or misaligned from any attachment points.This allows the device to accommodate growth of a recipient over time,while still allowing the fixation system to respond in a conventionalmanner to loads due to, for example, inertia.

This summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used to limit the scope of the claimed subject matter.

BRIEF DESCRIPTION OF THE DRAWINGS

The same number represents the same element or same type of element inall drawings.

FIG. 1A is a partial view of a fully-functional ear of a recipient.

FIG. 1B is a partial view of a direct acoustic stimulator worn on arecipient.

FIGS. 2A and 2B are side sectional and top perspective views,respectively, of a direct acoustic stimulator bracket for use in adirect acoustic stimulator.

FIG. 3 is a partial view of a direct acoustic stimulator implanted in arecipient.

FIG. 4 is a partial view of a direct acoustic stimulator that hasdisconnected from attachment with an internal ear structure of arecipient.

FIGS. 5A-5C depict schematic views of deformable mounting systems foruse in direct acoustic stimulators.

FIG. 6 is a partial view of a direct acoustic stimulator implanted in arecipient.

FIGS. 7A and 7B depict schematic side views of a viscoelastic elementutilized in deformable mounting system of a direct acoustic stimulator.

FIGS. 8A and 8B depict plots of stress and strain of a viscoelasticmaterial utilized in a direct acoustic stimulator.

DETAILED DESCRIPTION

FIG. 1A is perspective view of fully functional ear of a recipient. Therecipient has an outer ear 101, a middle ear 105 and an inner ear 107.Components of outer ear 101, middle ear 105 and inner ear 107 aredescribed below. In a fully functional ear, outer ear 101 comprises anauricle 110 and an ear canal 102. An acoustic pressure or sound wave 103is collected by auricle 110 and channeled into and through ear canal102. Disposed across the distal end of ear canal 102 is a tympanicmembrane 104 which vibrates in response to sound wave 103. Thisvibration is coupled to oval window or fenestra ovalis 112 through threebones of middle ear 105, collectively referred to as the ossicles andcomprising the malleus 108, the incus 109 and the stapes 111. Bones 108,109 and 111 of middle ear 105 serve to filter and amplify sound wave103, causing oval window 112 to articulate, or vibrate in response tovibration of tympanic membrane 104. This vibration sets up waves offluid motion of the perilymph within cochlea 140. Such fluid motion, inturn, activates tiny hair cells (not shown) inside of cochlea 140.Activation of the hair cells causes appropriate nerve impulses to begenerated and transferred through the spiral ganglion cells (not shown)and auditory nerve 114 to the brain (also not shown) where they areperceived as sound.

FIG. 1B is a perspective view of a direct acoustic stimulator 200B,comprising an external component 242 which is directly or indirectlyattached to the body of the recipient, and internal component 244B whichis implanted in the recipient. Elements of the ear are depicted anddescribed above in FIG. 1A and are thus necessarily not describedfurther. External component 242 typically comprises one or more soundinput elements, such as microphones 224, sound processing unit 226, apower source (not shown), and an external transmitter unit (also notshown). The internal component 244B comprises internal receiver unit232, stimulator unit 220, and stimulation arrangement 250B. Stimulationarrangement 250B is implanted in middle ear 105. For ease ofillustration, ossicles 106 have been omitted from FIG. 1B. However, itshould be appreciated that stimulation arrangement 250B can be implantedwithout disturbing ossicles 106.

Stimulation arrangement 250B comprises actuator 240, stapes prosthesis254 and coupling element 253 connecting the actuator 240 to the stapesprosthesis 254. A bracket (depicted and described below with regard toFIGS. 2 and 3) maintains a position of the actuator 240. In thisexample, stimulation arrangement 250B is implanted and/or configuredsuch that a portion of stapes prosthesis 254 abuts round window 121. Itshould be appreciated that stimulation arrangement 250B canalternatively be implanted such that stapes prosthesis 254 abuts anopening in horizontal semicircular canal 126, in posterior semicircularcanal 127 or in superior semicircular canal 128.

A sound signal is received by one or more microphones 224, processed bysound processing unit 226, and transmitted as encoded data signals tointernal receiver 232. Based on these received signals, stimulator unit220 generates drive signals that cause actuation of actuator 240. Thisactuation is transferred to stapes prosthesis 254 such that a wave offluid motion is generated in the perilymph in scala tympani. Such fluidmotion, in turn, activates the hair cells of the organ of Corti.Activation of the hair cells causes appropriate nerve impulses to begenerated and transferred through the spiral ganglion cells (not shown)and auditory nerve 114 to the brain (also not shown) where they areperceived as sound.

FIG. 1B provides an illustrative example of a direct acoustic stimulatorsystem, more specifically, a direct acoustic cochlear stimulator. Amiddle ear mechanical stimulation device can be configured in a similarmanner, with the exception that instead of the actuator 240 beingcoupled to the inner ear of the recipient, the actuator is coupled to amiddle ear structure of the recipient. For example, the actuator canstimulate the middle ear by direct mechanical coupling via a couplingelement (e.g., similar to coupling element 253) to ossicles 106 or toincus 109, which are depicted in FIG. 1A. The technologies disclosedherein can be used in conjunction with both of these types of auditoryprostheses, depending on recipient need. Additionally, the technologiescan be used in other medical implant applications where accommodation ofgrowth or positional changes to bone or connective or other tissue aredesired. For clarity, however, the technologies will be described belowin the context of direct acoustic cochlear implants. The middle earmechanical stimulation device or the direct acoustic cochlear implantcan each be referred to generally as a direct acoustic stimulator.

FIGS. 2A and 2B are side sectional and top perspective views,respectively, of a direct acoustic stimulator bracket 300 for use in adirect acoustic stimulator. FIGS. 2A and 2B are describedsimultaneously. The direct acoustic stimulator bracket 300 includes anumber of subparts or components that aid in securing an actuator to arecipient such that stimulation can be delivered to the recipient'sinternal ear structure. A fixation element 302 defines a number ofopenings 304 therein for receipt of bone screws. The fixation element302 includes a bone plate 306 that defines the openings 304. The boneplate 306 is connected to a clamp plate 308 via a transition 310. Eachportion of the fixation element 302, the bone plate 306, clamp plate308, and transition 310 can be configured as required or desired for aparticular application. In general, the fixation element 302 is sizedand configured so as to be secured to the skull of the recipient. Anadjustable joint 312 is used to further align an acoustic actuator (notshown) with the desired internal ear anatomy, as described in furtherdetail below. The adjustable joint 312 includes a ball clamp 314 that,along with the clamp plate 308, defines a socket and secures a ball 316.A position of the ball 316 can be set utilizing a clamp screw 318. Aball plate 320 extends from the ball 316 and enables positioning of anactuator assembly 322 that includes an actuator plate 326 and anactuator clamp 328 for retaining the acoustic actuator.

FIG. 3 is partial view of a direct acoustic stimulator 400 implanted ina recipient R. The direct acoustic stimulator 400 includes the bracket300 as described above that secures an actuator 402, via the actuatorring 328. Certain subparts or components of the bracket 300 aredescribed above with regard to FIG. 2 and thus are not describedfurther. The bone plate 306 is secured to a skull of the recipient R viaa number of bone screws 404. The actuator 402 is in communication withthe sound processing components described above via a wire 406. In thisembodiment, the actuator 402 drives a coupling or actuation rod 408. Thecoupling rod 408 can be connected to a mounting structure 410 that isconnected to an actuating prosthesis or attachment element 412. Incertain embodiments, attachment element 412 is attached to the mountingstructure 410 by a wire or rod that is wound around and crimped to themounting structure 410. The attachment element 412 penetrates an openingO in the cochlea C, and is secured thereto by the fluid tensiondisplayed by fluid within the cochlea. Thus, in this embodiment, theattachment element 412 is a stapes prosthesis and is attached to theinner ear of the recipient. In the illustrated embodiment the stapesprosthesis passes through stapes footplate into the cochlea. In otherembodiments, the acoustic stimulator can be connected to a portion ofthe middle ear, for example, the stapes or ossicle. When connected tothe middle ear, the attachment element 412 is an ossicular chainprosthesis. Depending on the size of the opening O in the cochlea C,scar tissue can form around the attachment element 412, further securingthe attachment element 412 to the cochlea C. The mounting structure 410and attachment element 412 transmit movement of the coupling rod 408 tothe fluid within the cochlea C, along an axis A. By orienting theattachment element 412 along axis A during implantation, the forcesassociated with movement of the cochlear rod 408 are directed into thecochlea C to ensure efficient therapy. A distance D₁ between an anchorpoint (e.g., the screw 404, bone plate 306, etc.) and an attachmentpoint (e.g., the interface between the attachment element 412 and theopening O) is also depicted.

FIG. 4 is partial view of the direct acoustic stimulator 400 that hasdisconnected from attachment with an internal ear structure of arecipient R. Certain components depicted in FIG. 4 are described abovein FIG. 2 or 3 and are not necessarily described further. As the skullgrows G, the distance between the anchor point and the attachment pointcan increase to a distance D₂. As depicted, this can cause theattachment element 412 to separate S from the opening O, due to thefairly weak retention force holding the attachment element 412 in theopening O. This can cause a loss or reduction in therapy efficiency.Depending on the strength of the bone screws 404 and force created bythe new distance D₂, the bone plate 306 could instead separate. Even ifboth the bone plate 306 and attachment element 412 remain connected totheir respective attachment points, the difference between the originaldistance D₁ and the new distance D₂ can cause a bending or twisting ofany or all of the coupling rod 408, mounting structure 410, andattachment element 412. This can cause a misalignment of the attachmentelement 412 relative to the axis A, which can alter the forces appliedby actuator 402. This, too, can reduce therapy efficiency. For at leastthese reasons, aspects of the technology incorporate a deformablematerial into one or more components of the direct acoustic stimulator400.

Different types of deformable materials can be utilized in the mountingsystems described herein. In certain embodiments, a deformable materialis a material that can flex, stretch, or bend from an original positionto a deformed position and then return substantially to its originalposition. In other embodiments, deformable materials can deform from anoriginal position to a deformed position and still maintainfunctionality. That is, the material can deform to a deformed positionwithout being susceptible to failure. Acceptable deformable materialsinclude viscoelastic materials, such as thermoplastic polycarbonatepolyurethane (PCU), such as the Bionate PCU family of materialsmanufactured by DSM Biomedical Inc., of Berkeley Calif. Other acceptableviscoelastic materials include ultra-high-molecular-weight polyethelene(UHMWPE).

FIGS. 5A-5C depict schematic views of deformable mounting systems 500for use in direct acoustic stimulators (either cochlear stimulators ormiddle ear stimulators). Such deformable monitoring systems 500 can beutilized to overcome separation, misalignment, and other problemsassociated with known direct acoustic stimulator brackets, such asdescribed with regard to FIG. 4. The deformable mounting systems 500 aredepicted as basic two-dimensional schematics for clarity, so as toexplain the properties thereof. Of course, structure incorporating thedisclosed teachings can be three-dimensional. In FIG. 5A, a deformablemounting system 500 includes a fixation element 502, an attachmentelement 504, and a linkage structure 506. In general, the linkagestructure 506 can be any single component, or pluralities thereof, thatconnect the fixation element 502 to the attachment element 504. Thedeformable mounting system 500 is fixed at two anchor points A, B, whichcorrespond to two discrete anatomies in a human body. For example,anchor point A can be at the skull, and anchor point B can be at theinner ear or middle ear anatomy. In general, the fixation element 502and the attachment element 504 are the components of the deformablemounting system closest to their respective anatomies. Anchor point Ahas a position that can be quantified as x₁, y₁, z₁, while anchor pointB has a position that can be quantified as x₂, y₂, z₂. Thus, the twoanchor points are separated by a distance D, which can be considered thedistance at implantation of a direct acoustic stimulator incorporatingthe deformable mounting structure 500.

The linkage structure 506 can include a plurality of links or components506 a, 506 b, and can also include an actuator element 508, such as theacoustic actuator described herein. In general, the actuator element 508is the only component of the deformable mounting structure 500 that isnot deformable. Joints or connection points between the variouscomponents of the deformable mounting structure 500 are depicted aspoints 1-6. Of course, depending on the number of discrete components inthe linkage structure, a greater or fewer number of connection pointscan be utilized. Notably, when connected to two discrete anatomies,points 1 and 6 can act as anchors. These anchors include but are notlimited to, bone screws, bolts, plugs, adhesives, and combinationsthereof. Additionally, body structures such as scar tissue, clottedblood, bone or tissue growth, or fluids that display retentiveproperties, can also act as anchors, although the retention strengthassociated therewith is fairly low. The points 1-6 can also includerigid or flexible connections, such as joints, hinges, sliding elements,formed interfaces, bolts, screws, adhesives, or combinations thereof.Any of the components 502-506, points 1-6, or portions thereof can bemanufactured in whole or in part of a deformable material such as aviscoelastic material so as to accommodate the separation of anchorpoints A, B, resulting due to bone growth.

FIG. 5B depicts the deformable mounting system 500 of FIG. 5A, where thedistance between anchor points A, B has increased to distance D₂, whichis greater than distance D₁. This new distance D₂ can be the result ofgrowth of the recipient, and causes the anchor point B to be disposed ata new spatial position characterized by x₃, y₃, z₃. Of course, spatialpositions of both anchor points A, B can change, while distance D₁remains the same. In the depicted embodiment, the attachment element504′ is a deformable element and deforms to accommodate distance D₂,preventing disconnection of the attachment element 504′ from anchorpoint B or the fixation element 502 from anchor point A.

FIG. 5C depicts the deformable mounting system 500 of FIG. 5A, where thedistance between anchor points A, B has maintained distance D₁, eventhough anchor point B being is disposed at a new spatial positioncharacterized by x₄, y₄, z₄. Of course, spatial positions of both anchorpoints A, B can change while distance D₁ remains the same. In thedepicted embodiment, the linkage structure portion 506 a′ is adeformable element and deforms to accommodate the new spatial positionof anchor point B, preventing disconnection of the attachment element504′ from anchor point B or the fixation element 502 from anchor pointA.

In the embodiments of the deformable mounting system 500 depicted inFIGS. 5A-5C, other components of the deformable mounting system 500 canalso be manufactured in whole or in part of a deformable material so asto accommodate relative movement of or separation between anchor pointsA, B. That is, components between anchor point A and the actuatorelement 508, as well as components between the actuator element 508 andanchor point B can be manufactured of a deformable material. Thesecomponents can be in addition to or instead of the single componentindicated above as being deformable. Additionally, the above descriptionassumes that the connection of the deformable mounting system 500 isweakest at anchor points A, B. In other embodiments, for example, whereconnection is made at anchor points A, B with bones screws or otherrobust connections, the weakest connection can be within the deformablemounting system 500 itself. By utilizing deformable materials in thedeformable mounting system 500, failure of the deformable mountingsystem 500 itself can also be averted.

FIG. 6 is partial view of a direct acoustic stimulator 400 worn on arecipient R in accordance with aspects of the disclosure, as describedgenerally in FIGS. 5A-5C. Certain elements depicted in FIG. 6 aredescribed above in FIGS. 2 and 3 and are not necessarily describedfurther. Deformable elements such as viscoelastic materials can beincorporated into one or more of a fixation element 450′, an attachmentelement 412′, or a linkage structure 460′. In fact, any one or morecomponents, e.g., 306′, 308′, 310′, 314′, 320′, 326′, 404′, 408′, 140′,and/or 412′ can be manufactured of a viscoelastic material. For example,the fixation element 450′ can include a bone plate 306′ or securementelements 404′ that can be manufactured of a viscoelastic material. Thelinkage structure 460′ can be any of the components that connect thefixation element 405′ to the attachment element 412′. In the case of thesecurement elements 404′, specifically, these can be manufactured in theform of rods or shafts of viscoelastic material and adhered or otherwisesecured to the skull. As the skull grows and the distance D₁ in FIG. 3increases to the distance D₂ of FIG. 6, the viscoelastic material candeform so as to enable the attachment element 412′ to remain in contactwith the opening O, without the securement elements 404′ themselvesfailing.

The fixation element 450 is connected to a number of components thatdefine a linkage structure 460. Here, the linkage structure 460 includesa transition 310′ and a clamp plate 308′, either or both of which can bemanufactured of a viscoelastic material. In certain aspects, if theclamp plate 308′ is manufactured of a viscoelastic material, it can alsobe advantageous to manufacture the ball clamp 314′ of a viscoelasticmaterial so as to provide even deformation. In certain aspects, eitheror both of the ball plate 320′ and the actuator plate 326′ can bemanufactured of a viscoelastic material. The linkage structure 460 canalso include the actuator 402 and a coupling rod 408′ moved by theactuator 402 extending therefrom. The linkage structure 460 is connectedto an attachment element 412′ via a piston 410′. By utilizing aviscoelastic material in any number of the components identified above,growth of the recipient can be accommodated.

FIGS. 7A and 7B depict schematic side views of a viscoelastic elementutilized in a deformable mounting system 600 of a direct acousticstimulator. The deformable mounting system 600 is depicted in a greatlysimplified presentation so as to explain the function of a deformableelement or member 602. Here, the deformable element or member 602 is anelongate component of a viscoelastic material and links a firstcomponent 604 and a second component 606. In FIG. 7A, the firstcomponent 604 and the second component 606 are separated by a firstdistance D₁. The deformable element 602 includes an elongate axis A. Asthe distance between the first component 604 and the second component606 increases, e.g., to a second distance D₂ depicted in FIG. 7B, theviscoelastic deformable element 602 deforms along its elongate axis A.This deformation allows the connection between the first component 604and the second component 606 to be maintained. This is analogous withmaintaining a connection between two discrete anatomies within a body,while utilizing a deformable mounting system having at least onedeformable element.

FIGS. 8A and 8B depict plots of stress and strain of a viscoelasticmaterial utilized in a direct acoustic stimulator. The viscoelasticmaterial will yield gradually to decay internal stresses. Thus, whenused in the context of an auditory prosthesis, as described herein, asthe skull grows, the strain on the device increases linearly, asdepicted on the left hand side of FIG. 8A. As a result, the stress inthe viscoelastic material will also increase slightly, as depicted onthe left hand side of FIG. 8B. However, the stress on a viscoelasticmaterial will not increase as much as a conventional linear elasticmaterial. This is the case because a viscoelastic material relaxes underthe presence of strain. In that regard, once the skull is full-grown,the strain no longer increases and instead remains constant, as depictedon the right-hand side of FIG. 8A. As a consequence, the internal stressdecays until zero stress remains, as depicted on the right-hand side ofFIG. 8B.

This viscoelastic behavior is exhibited at long periods of time or,equivalently, at very low mechanical frequencies. This means that innormal day-to-day activities, a direct acoustic stimulator incorporatinga viscoelastic material responds very conventionally to various loadsdue to inertia. For example, the direct acoustic stimulator will notdeform because the recipient is in a car that takes a sharp turn. Theviscoelastic material behaves as a high-pass filter. That is, it behavesstiff in response to high frequency mechanical input and dampens verylow frequency mechanical input, such as the slow growth of a skull. Inthat case, the viscoelastic material deforms only due to stresses placedon it due to loads applied over a predetermined length of time. In thedescribed context, this predetermined length of time can be at least oneyear, and can accommodate anatomical growth during that year. Theleniency of viscoelastic material is not exhibited in response to shortduration accelerations such as those that are encountered in everydayactivities. Everyday activities can result in shocks, inertial forces,vibrations, and impacts being transferred, as is the case withconventional materials. Instead, the viscoelastic material is too slowto adapt to these relative high frequency inputs, due to the material'svery high viscosity. In other words, the cutoff frequency of thehigh-pass filter is too low to respond to such inputs.

By utilizing viscoelastic materials in a direct acoustic stimulator, itis possible to compensate for anatomical changes such as skull growthwithout surgical interventions later in life. The viscoelastic materialsaim for a neutral stress state in the long term, such that theefficiency of the therapy is not affected by bone growth, thus allowingfor implantation of such devices in pediatric patients.

This disclosure described some aspects of the present disclosure withreference to the accompanying drawings, in which only some of thepossible embodiments were shown. Other aspects can, however, be embodiedin many different forms and should not be construed as limited to theembodiments set forth herein. Rather, these embodiments were provided sothat this disclosure was thorough and complete and fully conveyed thescope of the possible embodiments to those skilled in the art.

Although specific aspects were described herein, the scope of thetechnology is not limited to those specific aspects. One skilled in theart will recognize other embodiments or improvements that are within thescope of the present technology. Therefore, the specific structure,acts, or media are disclosed only as illustrative embodiments. The scopeof the technology is defined by the following claims and any equivalentstherein.

What is claimed is:
 1. An apparatus comprising: a fixation element forfixing the apparatus to a skull of a recipient; an attachment elementfor attaching the apparatus to an internal ear structure of therecipient; and a linkage structure connecting the fixation element tothe attachment element, wherein at least one of the fixation element,the attachment element, and the linkage structure comprise a deformablematerial.
 2. The apparatus of claim 1, wherein the attachment elementcomprises at least one of a stapes prosthesis and an ossicular chainprosthesis.
 3. The apparatus of claim 1, wherein the deformable materialcomprises an elongate component comprising an axis, wherein thedeformable material is configured to deform along the axis.
 4. Theapparatus of claim 1, wherein the linkage structure comprises anacoustic actuator.
 5. The apparatus of claim 4, wherein the deformablecomponent is disposed between the fixation element and the acousticactuator.
 6. The apparatus of claim 4, wherein the deformable materialis disposed between the attachment element and the acoustic actuator. 7.The apparatus of claim 4, wherein the deformable material is adapted tobe moved by an actuation of the acoustic actuator.
 8. The apparatus ofclaim 1, wherein the linkage structure comprises a plurality of links,wherein at least one of the links comprises the deformable material. 9.The apparatus of claim 1, wherein the deformable material comprises aviscoelastic material.
 10. The apparatus of claim 1, wherein theinternal ear structure comprises at least one of an inner ear structureand a middle ear structure.
 11. An auditory prosthesis comprising: animplantable portion comprising: a first anchor adapted to be secured toa first location in a recipient; a second anchor adapted to be securedto a second location in the recipient; and a deformable element disposedbetween the first anchor and the second anchor, wherein the deformableelement is configured to deform over predetermined period of time toaccommodate a separation between the first location and the secondlocation.
 12. The auditory prosthesis of claim 11, wherein thedeformable element deforms so as to prevent disconnection of either ofthe first anchor from the first location and the second anchor from thesecond location due to the separation.
 13. The auditory prosthesis ofclaim 12, wherein the predetermined period of time comprises at leastone year.
 14. The auditory prosthesis of claim 11, wherein the firstanchor comprises a bone screw and wherein the second anchor comprises atleast one of a stapes prosthesis and an ossicular chain prosthesis. 15.The auditory prosthesis of claim 11, wherein the deformable elementcomprises a viscoelastic material.
 16. The auditory prosthesis of claim11, further comprising a linkage structure connecting the first anchorand the second anchor, wherein the linkage structure comprises aplurality of links, and wherein at least one of the links comprises thedeformable element.
 17. The auditory prosthesis of claim 11, furthercomprising an acoustic actuator disposed between the first anchor andthe second anchor.
 18. The auditory prosthesis of claim 17, wherein thedeformable element is adapted to be moved by an actuation of theacoustic actuator.
 19. An apparatus comprising: a fixation element forfixing the apparatus to a skull of a recipient, wherein the fixationelement comprises a first anchor; an attachment element for attachingthe apparatus to an internal ear structure of the recipient, wherein theattachment element comprises a second anchor; and a deformable elementdisposed between the fixation element and the attachment element,wherein the deformable element is configured to deform such that: theapparatus comprises a first distance between the first anchor and thesecond anchor at a time of implantation of the apparatus into arecipient, and the apparatus comprises a second distance between thefirst anchor and the second anchor a predetermined period of time afterimplantation of the apparatus into the recipient.
 20. The apparatus ofclaim 19, wherein the second distance is greater than the firstdistance.
 21. The apparatus of claim 19, wherein the predeterminedperiod of time is at least one year.
 22. The apparatus of claim 19,further comprising a linkage structure connecting the fixation elementand the attachment element, wherein the linkage structure comprises thedeformable member.
 23. The apparatus of claim 22, wherein the linkagestructure comprises a plurality of links, wherein at least one of thelinks comprises the deformable member.
 24. The apparatus of claim 19,wherein the deformable member comprises a viscoelastic material.
 25. Theapparatus of claim 19, wherein the fixation element comprises a bonescrew.
 26. The apparatus of claim 19, wherein the attachment elementcomprises at least one of a stapes prosthesis and an ossicular chainprosthesis.
 27. The apparatus of claim 19, wherein the linkage structurecomprises an acoustic actuator.
 28. The apparatus of claim 27, whereinthe deformable element is adapted to be moved by an actuation of theacoustic actuator.
 29. The apparatus of claim 19, wherein the internalear structure comprises at least one of an inner ear structure and amiddle ear structure.